In 2002, 99,000 Americans died from HAIs (Klevens, et al., 2007). In addition to the annual toll in human lives and suffering, HAIs carry with them a price tag of approximately $30 billion a year (Scott, 2009). The research application offered by the Texas A&M Health Science Center and its collaborators emphasizes the prevention and management of HAIs in a community care setting serving one of our most vulnerable populations - those approximately three and one-quarter million frail Americans who each year reside for some period of time in a nursing home (CMS, 2009). The proposed intervention is an innovative approach because it addresses the needs of both long-term residents and short-term residents who have been discharged from or are destined for admission to another health care setting where the effects of an HAI might be as devastating as in the nursing home itself. Should the intervention work as intended, it will affect Tier 1 providers, as well as the targeted Tier 2 providers, by clearly conveying information about the presence of infection at the point of transition to acute care. This should improve the quality of care provided by the receiving institution and reduce its financial risk, especially because the presence of infections at hospital admission now affects reimbursement. The planned intervention has two components: a state-of-the-art Clostridium difficile infection control protocol for nursing homes and a communication component used by nursing homes and hospitals to which they send residents and from which they admit residents to document the suspected presence of HAIs for individuals transitioning between these care settings. In its approach, the intervention is more "naturalistic" than most HAI interventions. It emphasizes both the individual and the infection as they move among different providers, instead of treating HAIs as problems that exist within the walls of a single institution. We test this intervention approach on Clostridium difficile, a potentially deadly HAI resulting from antibiotic use that affects the digestive tract, is especially difficult to eradicate, and for which age is a major risk factor. We have four specific aims: 1. Improving nursing home management of Clostridium difficile (C. difficile) infections using a state-of-the- art Infection Control Bundle; 2. Improving the control of C. difficile through enhanced communication among care providers concerning C. difficile and other dangerous HAIs as individuals transition between nursing homes and hospitals; 3. Determining the cost of the intervention, potential savings resulting from the intervention, and the most cost-effective strategy for implementing the intervention;and 4. Untangling the complex relationship between hospitals and nursing homes to determine the degree to which each type of provider (nursing home and hospital) serves as a source for C. difficile among those transferred to the other type of provider (nursing home to hospital or hospital to nursing home). The results of the proposed project will have implications for both practice and policy. PUBLIC HEALTH RELEVANCE: Relevance to public health Estimates indicate that health care associated infections (HAIs) take almost 100,000 lives each year and cost approximately $3 billion annually. This project involves testing an intervention aimed at reducing Clostridium difficile (C diff) among those frail individuals who live in or pass through nursing homes. The intervention has the potential to reduce HAIs in nursing homes and in those health care settings to which nursing homes discharge residents.